Introduction:
Cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging has been shown to provide prognostic information in patients with chronic heart failure. However, little is known about the prognostic value of cardiac MIBG imaging in patients admitted with acute decompensated heart failure (ADHF).
Hypothesis:
We assessed the hypothesis that cardiac MIBG imaging might also be useful for the prediction of poor clinical outcome in patients admitted with ADHF.
Methods:
We studied 115 consecutive patients admitted for ADHF from October 2011 to January 2013 and discharged with survival (age: 74±13 years, male: 56%, NYHA class at discharge: 2.2±0.8, left ventricular ejection fraction measured by echocardiography: 47.1±15.5%). Cardiac MIBG imaging, echocardiography and venous blood sampling were performed just before discharge. The cardiac MIBG heart-to-mediastinum ratio (H/M) and washout rate were calculated from the chest anterior view images obtained at 20 and 200min after isotope injection. The endpoints were unplanned hospitalization for worsening heart failure (WHF) and pump failure death (PFD).
Results:
During a follow-up period of 2.0±0.8 years, 32 patients had WHF and 15 patients had PFD. At multivariate Cox analysis, out of the variables including clinical, hemodynamic, biochemical, echocardiographic and MIBG parameters, H/M on delayed image (late H/M) was independently associated with WHF (p=0.0003) and PFD (p=0.0255), although brain natriuretic peptide showed the significant association with the endpoints at univariate analysis. Kaplan-Meier analysis showed that the patients with late H/M <1.65 (mean value) had a significantly higher risk of both WHF and PFD than those with late H/M ≧1.65 (Figure).
Conclusions:
Cardiac MIBG imaging could predict poor outcome even in patients admitted with ADHF.
Iodine-123 mIBG Imaging for Predicting the Development of Atrial Fibrillation